Five Quick-Takes from the ADA 77th Scientific Sessions

A1C is out, add-on drug therapies are in, and hybrid closed-loop pumps are the now and the near future.

Photo by © ADA/Todd Buchanan 2017


We just got back from the ADA 77th Scientific Sessions in San Diego, California. Here’s a jet-lagged and sleep-deprived look at five of the trends that we saw from the first three days of the conference:

1. Add-ons to insulin are going to be a thing for Type 1 diabetes.

Pharmaceutical companies are coming to terms with the limits and costs of designing better insulin, and generic or biosimilar insulins are entering the marketplace. It’s no coincidence, then, that there has been renewed interest in looking at other drugs for treating those with Type 1 diabetes.

A presentation of several studies on SGLT2 and SGLT1 drugs as an addition to insulin therapy drew a large crowd, as well as a few appreciative murmurs from researchers when modest improvement in A1C scores were announced. Another major study that was trumpeted by the ADA found SGLT2 use reduced heart disease and kidney disease risk for those with Type 2 diabetes. Less discussed was the growing concern from studies that suggest SGLT2 use increases the risk of diabetic ketoacidosis, or the FDA’s warning that there is increased amputation risk with SGLT2s.

Researchers also presented separate findings on metformin and GLP-1 drugs for people with Type 1 diabetes. While the A1C benefits of those studies failed to impress in the same way, both drugs did show weight loss benefits for people with Type 1 diabetes. This is important because researchers are discovering that…

2. A1C shouldn’t be the only yardstick for treating people with Type 1.

There was a lot of discussion about weight and Type 1 diabetes. Researchers have found tactful ways of saying, “Yes, people with Type 1 can be obese, no-I-am-not-saying-Type-1-is-the-same-as-Type-2.”

Now, they are starting to discuss how to address the obesity issue, as it impacts quality of life and glucose control. Just as importantly, researchers were also discussing the prevalence of eating disorders as it relates to Type 1 diabetes. Their research shows that some form of disordered eating is pretty common among those with Type 1 diabetes and that we lack adequate resources to address it.

Also, researchers are daring to suggest that the newest insulin formulations aren’t going to do much good if people can’t afford to buy them or are driven into poverty to buy them. In a session that included a shameful amount of empty seats, one presenter even suggested we consider clinically reevaluating the effectiveness of older insulins because, you know, people with diabetes don’t have to work 80 hours a week to afford them.

That researcher probably received a lot of handshakes from diabetes activists during the weekend because…

3. The pitchforks were out.

In the same presentation, another researcher described how the price of insulin has skyrocketed in recent years and that incremental improvements in insulin don’t justify their increased price tag. Another presenter described how he wasn’t allowed to disparage insulin companies for their pricing because of a gag order clause in his contract. There was also a personal confession of how easy it is to be swayed by the drug company money that gets thrown at doctors. There was even a call for the ADA to better disclose when drug companies provide funding to the organization.

Whew!

But the most outrage of the weekend was expressed on Twitter by several dozen attendees of the conference when the ADA tweeted at them to delete photos of the conference. ADA’s social media policy called for conference photos to be taken only at designated places in front of backdrops with the ADA logo, with no photos taken at the sessions. Reporters were told not to tweet during sessions and that there were strict embargoes in place for study findings.

This strict policy and its enforcement were widely panned, especially when ADA social media monitors attempted to enforce the no photos policy on photos taken of off-site diabetes research gatherings happening at the same time. The ADA said it would reconsider its policy for the 78th Sessions.

Speaking of the future…

4. If your company’s next insulin pump isn’t at least a hybrid closed-loop pump, quit.

Medtronic officially launched its 670G for commercial sale in the U.S. just days before the 77th Sessions began. It can bask in the hybrid closed-loop insulin pump limelight for now, but it’s soon going to have to share it.

One presenter discussed 12 separate hybrid closed-loop insulin-only or insulin-and-glucagon pumps that are in the works, with some being further along than others. The ADA press room also highlighted a study that showed Omnipod’s closed loop pump system (a Pod pump paired with a Dexcom CGM) was effective in controlling glucose levels in kids and adults. Closed-loop hybrid technology, once considered sci-fi, is now being discussed matter-of-factly.

5. Beyond Type 1 gets bigger.

Beyond Type 1 announced that it will take over Tudiabetes.org and EsTuDiabetes.org, as the Diabetes Hands Foundation (DHF) closes for good. (Currently, the two websites still say they are a program as part of the DHF.) The announcement marks the closing of one of the original diabetes social networks and the continued rapid growth of another. It represented a bittersweet moment for many devoted to the Diabetes Hands Foundation.

Did you attend the 77th Scientific Sessions? What were your impressions? Send them to me at cidlebrook@selfrx.com.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.